[The intraoperative use of falipamil (AQ-A39), a new calcium antagonist with specific bradytropic properties].
Tachycardia caused by surgical stimulation can compromise the myocardial oxygen balance and may also lead to a reduction of cardiac output. Conventional drugs with negative chronotropic effects also cause reduction of inotropy. Recent so-called specific bradytropic agents are expected to act merely upon chronotropy without affecting pressure of the systemic or coronary circulation. The goal of this study was to investigate the effects of a calcium channel blocker. Falipamil, on the circulation controlling excessive intraoperative tachycardia. PATIENTS AND METHODS. In this study 15 patients, aged 32 to 73 years, mean 55 +/- 12 were investigated. The cardiac risk classes included classification I-III, according to Goldman. The patients underwent major abdominal or thoracoabdominal operations. Monitoring consisted of a radial arterial cannula, as well as a 7 French Swan-Ganz catheter, which was introduced via the internal jugular vein. Determination of cardiac output was done using the thermodilution technique with a Kimray Medical Association Oklahoma City model 3500; related indexes were calculated. Electrophysiological data were read from the ECG. The recorded QT interval was corrected for heart rate according to the formula of Hegglin and Holzmann. Anesthesia consisted of premedication with diazepam, 0.1 mg/kg, 1 h preoperatively. Anesthesia was induced with thiopentone, 5 mg/kg, and fentanyl, 1.5 micrograms/kg. After giving 1 mg alcuronium, succinylcholine, 1 mg/kg, was used for intubation. Anesthesia was continued using ventilation with O2: N2O 1:2 and intermittent doses of fentanyl and alcuronium. When tachycardia occurred at a rate higher than 100 beats per minute, a dose of 2 micrograms/kg fentanyl was administered to deepen the anesthesia. If this had no influence, control readings were taken and subsequently falipamil 2 mg/kg was injected. After that the hemodynamic parameters were monitored for 1, 2, 3, 5, 10, and 20 min. Statistical analysis was performed using the analyses of variance, followed by the Newman-Keuls test. The level of significance was p less than 0.05. RESULTS. The means and standard deviations of the hemodynamic parameters following induction of anesthesia (0) and at the peak rate are shown in Table 1. The mean increase in heart rate at that time was 38 +/- 18% and the QT and RR interval were reduced concomitantly. Both times the QT measured and the QT corrected for rate did not significantly differ from each other. (ABSTRACT TRUNCATED AT 400 WORDS)
Ilias
W
W
Krankenhaus der Barmherzigen Brüder, Abteilung für Anaesthesiologie und Allgemeine Intensivmedizin, Wien.
Lackner
F
F
Zimpfer
M
M
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D054833:Isoindoles; D008297:Male; D008875:Middle Aged; D010797:Phthalimides / Q000627:therapeutic use*; D013610:Tachycardia / Q000209:etiology / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D054833:Isoindoles; D010797:Phthalimides; C030532:falipamil
Zum intraoperativen Einsatz von Falipamil (AQ-A39), einem neuen Kalziumantagonisten mit spezifisch bradytropen Eigenschaften.